Are there differences in late outcome after PTCA for angina pectoris after non-Q wave vs Q wave myocardial infarction?

Abstract

Revascularization is thought to improve prognosis better if ischaemia persists after so-called non-Q wave myocardial infarction, than after Q-wave myocardial infarction, because it is assumed that prognosis is better where there is less left ventricular function loss. This study evaluates the differences in clinical outcome between patients with Q wave and those with non-Q wave myocardial infarction who underwent percutaneous transluminal coronary angioplasty because of recurrent ischaemia. We retrospectively analysed two consecutive groups of patients who underwent percutaneous transluminal coronary angioplasty for ischaemia after either a non-Q wave (n = 175) or a Q wave (n = 175) myocardial infarction, and who were followed for 4 years. Initial angioplasty success rates were similar in both groups. At follow-up there were no significant differences between the two patient groups in rates of death (9% vs 11%, P = ns), myocardial infarction (3% vs 7%, P = ns) and target vessel revascularization by repeat percutaneous angioplasty (11% vs 15%, P = ns) or coronary bypass surgery (both 7%). We conclude that elective coronary angioplasty in patients with angina pectoris after non-Q wave myocardial infarction does not lead to a better prognosis than after Q wave myocardial infarction. Thus, management strategies after myocardial infarction should not be based on the absence or presence of Q waves on the electrocardiogram.